Patient Presents With Incisional Keloid As Post-op Complication of Thoracic Surgery

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The New England Journal of Medicine

Patient presented with an incisional keloid after undergoing thoracic surgery as a post-op complication. A 24-year-old man underwent thoracic surgery for pulmonary hydatid disease. 8 weeks later, the patient started developing tumor-like, asymptomatic cutaneous lesion over the site of incision. There was no itching or swelling and the lesion gradually progressed with subsequent weeks, protruding on the skin causing an apparent aesthetic deformity.

Keloids occur typically in response to dermal injuries, for example, inflammatory skin conditions, burns, lacerations and surgical wounds. However, surgical removal is generally not recommended because recurrence is common. Treatments including radiotherapy, laser therapy and glucocorticoid injection may be tried but usually have a poor response outcome.

Fibrous tissue called scar tissue forms over the wound to repair when skin is injured to protect the injury. In some cases, there is a growth of extra scar tissue, forming hard and smooth growths called keloids. In many cases, keloids can be much larger than the original wound. In addition to this, they are most commonly found on the cheeks, earlobes, shoulders and chest. However, they can affect any other part of the body also. Although keloids are not harmful to your health, they may create cosmetic concerns for many patients.

The patient was undergoing adjunct therapy with albendazole. The patient was diagnosed with keloid based on the clinical presentation of the lesion and history of the patient. Histopathology confirmed the lesion to be a keloid. As mentioned above, radiotherapy, laser therapy and glucocorticoid injections are generally not recommended because of poor response and risk of recurrence. Considering the large size of the lesion in the patient, surgical excision was performed and an immediate infiltration of glucocorticoids was also done.

There was no recurrence of the lesion after 1 month of the surgical excision. The patient was lost to further follow-up.

References

Valenzuela Salas, I., & Fernandez Miralbell, A. (2015). Incisional Keloid. New England Journal of Medicine372(15), 1453-1453.

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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